Provider Demographics
NPI:1811545643
Name:CASTRO, SOL MARIAN
Entity Type:Individual
Prefix:
First Name:SOL MARIAN
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15470 BRAINBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-5123
Mailing Address - Country:US
Mailing Address - Phone:787-413-2032
Mailing Address - Fax:
Practice Address - Street 1:15470 BRAINBRIDGE CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-5123
Practice Address - Country:US
Practice Address - Phone:787-413-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant